[Monitoring sheet for the management of the diabetic patient in preparation for elective surgery]. / Scheda gestionale del paziente diabetico per la preparazione all'intervento chirurgico di elezione.

Diabetes represents a risk factor for patients undergoing surgery, not only in emergency but also in elective situations. All efforts in such patients are addressed to the restoration of the most physiologic conditions in respect for glucose balance and glucose metabolism since the preoperative phase, and during all the perioperative period. As these patients have to observe a more or less long period of preoperative and perioperative fasting since the day preceding the operation, any oral anti-diabetic regimen has to be timely discontinued, and the use of insulin is necessary. The doses of insulin have to be defined preoperatively with respect of the metabolic needs of the patients in the days preceding the operation, and must be able meanwhile to reduce blood glucose among the physiologic values, in absence on any urinary glucose, to restore a correct metabolism. The simple management form introduced in the paper for this purpose, and in use in our department through many years, makes easier getting and keeping all this aim and is extremely useful not only for the residents but also for the nurse staff. Its main characteristic is to offer daily, and for the single meal, a direct visual comparison of insulin dose and blood glucose level, in respect of a correct and constant caloric alimentation.

[Contribution to the knowledge on natural history of giant hepatic angioma]. / Contributo alla conoscenza della storia naturale dell'angioma epatico permagno.

Hepatic haemangiomas are mostly discovered by chance because of their limited dimensions. Their treatment is optional and very often an observing conservative strategy is adopted whilst a danger is foreseeing from different facts. Very different is the case of giant haemangiomas discovered because their bulk and discomfort coming from the compression exerted on near structures. In this cases a surgical treatment, segmentectomy or hemiepatectomy, are the current demanding choices. But if the volume of haemangioma is too bulky and occupies most hepatic parenchyma the necessary resection may be too extended and possibly dangerous. The two observations of the paper refer to two patients followed conservatively for over 20 years. In fact the volume of the haemangiomas in both patients was too large, the symptoms were only related to the weight of the mass and therefore a surgical solution was deferred to a possible worsening of the symptomatology. Such worsening didn't happen in the time for both the patients, demonstrating that the natural history of such lesion can also be very benign over many years.

[Deep parotidectomy with conservation of pre-neural tissue in the surgery for Warthin tumor]. / Parotidectomia profonda con conservazione del parenchima preneurale per tumore di Warthin.

The perfect acquaintance of the surgical anatomy of the parotid region associated to the rigid execution of the operative times by now standardized for the interventions on the parotid gland, they constitute a solid base of certainty on which found the own surgical choices. In some cases it's possible going away from the established rules to follow the impulses that the personal instinct suggests in the attempt of overcome unusual technical difficulty. The case in examination constitutes the tangible example to this enunciated, in which the technical difficulty of a neoplastic subneural bulk--the comfort on whose benignity arose from a preoperative FNAB (often but not always secure on the real histological nature)--that it could not be enucleated without dissect the trunk of the facial nerve, it imposed the adoption of technical extemporaneous solutions which, since dictate from the necessity of the moment, must not be recommended like rules to follow in all the situations, neither judged as rash surgical choices.

[Localization of preclinical nonpalpable lesions of the breast]. / Sulla localizzazione delle lesioni precliniche non palpabili della mammella.

The discovery of mammary neoplastic node in a preclinical stage, most of all not yet palpable, represents the best chance for the surgeon to obtain a real curative exeresis therapy retaining also gland's aesthetics. This kind of situation is more frequent today, because the increased utilization of mammography, ultrasonography and their matched use with the aim to investigate into a population of women with a specific risk. In fact, their sequential use offers the best possibilities of a real earlier diagnosis. In this event the conservative surgical treatment ranks its best curative and aesthetic result. The author's target, based on their own experience, outcomes the comparison between mammography and ultrasonography, pointing out a reliability of the latter similar to the mammography's one upon a specific target at least. The other aspect considered is the possibility of a preoperative localization of the neoplasm using different kind of marks to get the radical tumour exeresis centred on the suspect mass and conservative at its best. The experience suggests more usefulness of metallic marks strung down mammography control, even without using radio-stereotaxic that permits a higher precision but needs adequate facilities with unavoidable more elevated costs. It is finally layed emphasis on the importance of identifying a population at risk to logically utilize, and not indiscriminately, the most modern diagnostic resources.

[Scleronodular retrosternal Hodgkin's disease with cervical protrusion]. / Morbo di Hodgkin scleronodulare a localizzazione retrosternale con estrinsecazione cervicale.

The case of a retrosternal localization of Hodgkin disease is a very infrequent one, and its presentation as an inflammatory tumor is exceptional indeed. This case report of a young woman affected by a cervical tumour projecting in front of the sternal bone, both with fever and tenderness, gave a mistaken address toward a diagnosis of suppurative thyroiditis. But the rare evenience of this thyroidal affection made the diagnosis very improbable and the patient was treated by partial exeresis of the cervical mass and drainage of its apparently suppurative content. At the pathologic study the mass revealed its true nature, also if very unusual: the appearance of the specimen, studied also with immuno-chemical methods, revealed its true nature of scleronodular Hodgkin disease probably born on a thymic cyst remnant. Also the possibility of a suppurative evolution from a pyriform laryngeal sinus is discussed, but simply on a differential diagnostic basis for the original hypothesis of an inflammatory mass. The correct diagnosis instead offered the patient the possibility of the correct chemo-radio-therapeutic treatment and of final cure.

[The role of endoscopy in managing esophageal lesions caused by caustic fluids]. / Ruolo dell'endoscopia nella gestione delle lesioni esofagee da caustici fluidi.

In the paper is described the chronological outline adopted from the authors about the endoscopic treatment in case of oesophageal caustications, both in the emergency and, respectively, after one week and after one month. It is emphasized the importance of an endoscopic recognition within 6/12 hours after the caustic ingestion, to prevent the immediate acute complications, the later acute complications and the scarring evolutions of the healing. Important parameter for a clinical evaluation is represented by the volontariety of ingestion to which is connected the quantity of ingested caustic and than the extension of oesophageal lesions.

[The epidemiology of gallbladder cancer in Italy. ISTAT data 1970-1987]. / Epidemiologia del cancro della colecisti in Italia. Dati di fonte ISTAT 1970-1987.

The Italian surgeon needs to know the real situation about gallbladder carcinoma in Italy, his professional field of action: real incidence, sex and age characteristics and regional distribution with useful correlations to define the risk population. We can use nowadays the ISTAT data (since 1969 also in magnetic tape) about such neoplasia, based on death denunces. These differentiate gallbladder carcinoma from others hepatobiliary neoplasms and are referred to the whole national territory and allow and analyze for the various regions a period of 18 years (from 1970 to 1987). We have therefore the facility of a statistical index which give us the possibility to compare directly the specific mortality taxes between very different regions of residence from the point of view of population density, sex and age distribution on each year of the period considered. Also in Italy incidence of gallbladder carcinoma shows an absolute and relative increasing with age in both sexes, reaching the peak in the seventy's, with a M/F rate between 1/3 to 1/2, and with global incidence that is increasing in the last years. Risk factors could be in the age older than 50 years, in the females, in the long standing gallbladder lithiasis with wide cholesterinic stones on the basis of a chronic inflammation and consequent dysplasia, in the diet more far from the mediterranean's, and finally in papillomas and papillomatosis of gallbladder.

[Clinical research on the possibility that renal cysts may be responsible for the appearance of hematuria]. / Ricerca clinica sulla possibilità che le cisti renali siano responsabili della comparsa di ematuria.

New techniques of study, namely echography, urography, TC, give evidence of a great number of asymptomatic renal cysts in the everyday experience. Then also if haematuria was classically considered one of the symptoms of renal cysts, there are now many reasons to consider such evidence very infrequent, and downright there are some valid doubts that renal cysts may cause haematuria at all. So the authors have analysed 113 patients, most of them coming from Institute of Radiology of Chieti University Faculty of Medicine; all of them had renal cysts diagnosed by echographs and/or urography but only a minority were just from the beginning studied for haematuria, whereas the majority for many different symptoms. Total cases was then divided into two groups: one of 102 patients, all without haematuria; 78 of them had been studied only with echography, whereas other 24 patients had been examined both with echography and urography. The second group, of 11 cases, included all the patients who had both renal cysts and haematuria. Only in two cases of this second group was lacking evidence of any associated pathology which must be responsible for haematuria, whereas in all the other 9 cases a different aetiology of the haematuria was demonstrated, for simultaneous presence of various pathologies (cystopyelitis with associated prostatis, haemorrhagic cystitis, bladder diverticula and renal papillomas and upper urinary ways tumours), all much easier responsible by themselves of haematuria, also if with different features from case to case.(ABSTRACT TRUNCATED AT 250 WORDS)